Age Specific Guidelines for Non-Nursing Healthcare Professionals

In terms of movement and physical abilities, an infant 2 to 3 months of age should raise their head while lying on the stomach, push up slightly with the arms while on the stomach, open and close the hands, and hold on to and shake objects.

In terms of perceptual ability, an infant 2 to 3 months of age should be able to follow a moving object with their eyes, respond to a voice, and turn their head towards the direction of a sound.

In terms of social and emotional development, an infant 2 to 3 months of age will attempt to mimic facial expressions, begins to smile in response to people, and facial expressions become more numerous and complex.

Warnings signs of a possible serious growth and development issue in this age group include but are not limited to failure to respond to loud noises or to voice, inability to hold onto and move an object, failure to follow a moving object with the eyes, and failing to smile at people.

Children from the ages of 3 to 4 should have the movement and physical abilities to walk unassisted up a flight of stairs one step at a time, pedal a tricycle, throw a ball overhand, and turn a doorknob.

The social and emotional development behaviors that are considered normal for this age group would include expressing a wide range of emotions, copying adult behavior, and describing what others are feeling.

The cognitive and language abilities of the 3 to 4-year-old child should include an increasingly sophisticated sense of time, the ability to follow a short series of instructions, speaking in sentences and in simple paragraphs, and an ability to name familiar objects and friends.

Warnings signs of a possible severe growth and development issue in this age group include but are not limited to: Cannot follow simple commands, falls frequently or has difficulty climbing stairs, has unclear speech, does not imitate adults, does not make eye contact, or does not want to play with other children or toys.

Approach an infant or toddler calmly, gently, and slow manner. Have the caregiver hold the patient when assessing or treating the patient. If the child must lie down, let the parent stay next to the child (Trietz et al., 2018). Use warm instruments, warm hands, and allow the child to manage equipment if this is safe; some children find this reassuring. Explain to the caregiver that the child may cry when a procedure is begun but that an infant does not connect the approaching stimulus and pain. With toddlers, try to assess or treat a game to reduce fear. Use your imagination and get the toddler involved by using storybooks, dolls, or puppets. Provide reassurance during the assessment or procedure. Praise the child for doing well.

Preschoolers are very active. Motor skills are improving. Mentally, they begin using symbols and improving their memory. They have vivid imaginations, which may cause unseen fears. The preschooler is starting to develop independence sensitive to others' feelings.

Speak at the language level the child can understand. Explain to the child just before a procedure what will be done, using sensory terms when possible. Use games and imagination to gain cooperation. Allow the child to manage the equipment if possible. Enlist the child's help and allow him to express his feelings. Preschoolers need praise, rewards, and easy-to-understand rules.

School-aged children grow slowly until puberty. Mentally they are active and eager learners who can understand cause and effect. Building self-esteem is an important task during this period. The school-aged child is developing a greater sense of self independence, and he wants to fit in with peers. The school-aged child begins to make lifestyle choices and may act with poor judgment. Peer pressure, alcohol, sex, drugs, and smoking need to be discussed with this age group.

Because of these issues, the school-aged child needs to make decisions when feasible and within reasonable bounds. Provide privacy during assessment or treatment and explain all procedures at the child's level of understanding. Be prepared to listen and be honest. Tell the child how they can be involved in his own care, and have children assist you in their care, if possible. Reassure the child that they did nothing wrong. They need to know that the illness or injury is not a punishment.

The incidence of child abuse is difficult to ascertain. Still, it is a prevalent social issue with serious short-term and long-term consequences (CDC, 2019a). The CDC estimated that 1 in 7 children in any year is abused. This number is an underestimate (D and approximately 12% of abused children are injured (again, likely to be an underestimate) and that 10% of children taken to an ER have been abused or neglected (CDC, 2019a). In addition, the statistics of child abuse can be deceiving (Dudas et al., 2019) because a child that is abused would be considered one case. Still, that child is likely to be abused many, many times.

Child abuse can be emotional, physical, psychological, and sexual. It can also be in neglect and caregiver fabricated illnesses, the last being commonly called Munchhausen by proxy (CDC, 2019a). Risk factors for child abuse include (but are not limited to murder) (CDC, 2019a):

1. Characteristics of the child: Children under age 3 and special needs children are more likely to be abused.
2. Parental factors: The parent/caretaker was abused, has alcohol and/or substance abuse and/or mental illness, the caretaker is not biologically related to the child, the parent/caretaker is very young.
3. Environmental/social factors: Domestic violence, poverty, social isolation.

There are many characteristic signs and symptoms and patterns of injury associated with physical abuse like bruises, burns, specific fractures, and head trauma, all of which are indicators of that child abuse. For screening and detection purposes, clinicians should also keep in mind that the emotional and psychological condition of the child and the history surrounding incidents of child abuse are important. When considering the possibility of child abuse, consider these three issues.

• Child-caregiver interaction: Is the child agitated, fearful, or otherwise emotionally and/or psychologically upset with the caregiver? What are the caregiver's attitude and behavior towards the child – attentive and concerned or cold, disinterested, and harsh?
• History of the injury: Does the caregiver's story of how and why the injury occurred make sense? Did the caregiver delay get help for an injured child? Has the child had previous injuries or had the same injury? Are the injuries increasing in frequency and severity? Does the child have an injury or a medical condition that could not happen to a child, like genital trauma, a sexually transmitted disease, or physical trauma that could not happen to a child given their age, body weight, and level of physical activity? Does the child have bruises or fractures that are clearly days, weeks, or months old, but the caregiver claims that the child was just injured?
• Condition of the child: Is the child well nourished? Do they have frequent illnesses or injuries? Is the child withdrawn, apathetic, or fearful?

Healthcare professionals have a duty to report child abuse in professional ethics codes, the standards of healthcare facilities, and state and local statutes. The Federal Child Abuse Prevention and Treatment Act requires every state to have procedures that detail who is required to report child abuse. Every state designates which professions are included. See Mandatory Reporters of Child Abuse and Neglect, published by the US Department of Health and Humans and available online using this link.

The CDC's publication Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities, 2016, provides guidelines, plans, and resources for preventing child abuse. The publication can be accessed using this link. Other information from the CDC on this topic is on their website.

Accidental injuries like burns, drowning, falls, and automobile accidents are the number one cause of death in children 4 years of age and younger (CDC, 2019a).

Poisonings are a significant source of injury to children, as well. Most poisonings happen in children, and every year in the US, hundreds of thousands of children are poisoned or exposed to a potentially toxic substance (Poison Control, 2019). The CDC reported that every day in the United States, three hundred children are treated in ERs for a poisoning emergency. Two children die due to being poisoned (CDC, 2019a).

Children are naturally curious, and exploring the environment is part of the growth process. They are much more likely to use hand-to-mouth behavior to determine the nature of an object, and they also lack the caution of older children. Serious harm and death caused by pediatric exploratory behavior are unusual; however, children are especially vulnerable to the effects of medications and hazardous substances because of body weight, and even one dose of certain medications or a tasting number of certain substances can cause serious harm or death in a child (Biro & Chan, 2018).

Poisoning prevention during childhood is often a matter of simple, commonsense interventions like making sure that children cannot have access to medications and hazardous substances. The AAP has a poisoning prevention information/tips page on their website.

Safety issues of particular concern with adolescents are sexually transmitted diseases, alcohol, drug, and tobacco abuse/use, depression and suicide, accidents, and unintentional injuries, especially automobile accidents and interpersonal and sexual violence (CDC, 2016).

Major depression in adolescents is a common and serious problem. It is associated with acute and chronic morbidity and mortality (Zuckerbrot et al., 2018). In 2018 approximately 1 in 7 adolescents aged 12 to 17 had had a major depressive event in the past year, and 1 in 10 had had a major depressive event with severe impairment (CDC, 2014). Major depression in adolescents also frequently goes unrecognized, and the AAP and the USPSTF recommend depression screening starting at age 12 (USPS, 2019). The AAP recommends using the Patient Health Questionnaire-2 (PHQ-2) as a screening tool, but clinicians can also use other screening tools; information about these can be found in the GLAD-C toolkit; this can be viewed by using this link.

Suicide is the second leading cause of death in 12- to 25-year-olds. The suicide rate in American adolescents has been steadily increasing in the past 10 years (AACAP, 2019). Most adolescents who attempt or commit suicide have a serious psychiatric disorder, usually depression. Other factors that put adolescents at risk for suicide include (but are not limited to) anxiety disorders, emotion, physical and sexual trauma, family conflict, feelings of hopelessness, and a stressful life event (O'Brien et al., 2019).

Accidents and unintentional injuries are the number one cause of death in adolescents. Most of these deaths are caused by automobile accidents (Heron, 2017). Risky behavior is common during adolescence. The Youth Risk Behavior Surveillance, 2017, reported that 5.9% of adolescents never or rarely wore a seat belt, 16.5% had ridden in a car driven by someone who had been drinking, 15.7% had carried a weapon, and 13.8% did not use any contraceptive method while having intercourse (CDC, 2016c).

The Youth Risk Behavior Surveillance, 2017, reported that 6.0% of students had been threatened with a weapon or injured with a weapon, and 23.6% had been in a physical fight (CDC, 2016c). Regarding sexual violence, 7.4% of students had been forced to have sexual intercourse, and 68.3% had been forced to perform a sexual activity by someone they had been dating (CDC, 2016c).

The CDC's program, STOP SV: A Technical Package to Prevent Sexual Violence, is not designed explicitly for adolescents. Still, it provides basic information on the topic (CDC, 2016c). The STOP SV program can be accessed by using this link.